Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Cancer Epidemiol Biomarkers Prev. 2018 Nov;27(11):1265-1274. doi: 10.1158/1055-9965.EPI-17-0430. Epub 2017 Jul 27.
Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends. We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013. Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, < 0.05), while temporal trends remained stable in urban areas. Cancer rates associated with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)-were higher in rural compared with urban populations. Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations.
美国的癌症发病率和死亡率正在下降，但这一趋势在农村地区可能并不明显，因为农村地区的居民更有可能生活贫困、吸烟和放弃癌症筛查。然而，目前关于全国农村和城市地区癌症发病率和趋势的差异的研究有限。我们分析了北美癌症登记协会公共使用数据集的数据，该数据集包括来自 46 个州的基于人口的癌症发病率数据。我们计算了年龄调整后的发病率、比率比和年百分比变化（APC）：所有癌症合并、选定的个别癌症以及与烟草使用和人乳头瘤病毒（HPV）相关的癌症。根据 2009 年至 2013 年的人口统计学、地理和社会经济特征，对城乡进行了比较。对 1995 年至 2013 年的趋势进行了分析。除了南部地区，城市人口的综合癌症发病率通常较高，尽管城市的发病率下降幅度大于农村人口（分别为 10.2%和 4.8%）。农村癌症差异包括在大多数人群中，与烟草相关的癌症、HPV 相关的癌症、肺癌和支气管癌、宫颈癌和结直肠癌的发病率较高。此外，农村地区 HPV 相关癌症的发病率呈上升趋势（APC=0.724，<0.05），而城市地区的时间趋势保持稳定。与可改变的风险相关的癌症发病率——烟草、HPV 以及一些预防性筛查方法（例如，结直肠癌和宫颈癌）——在农村地区高于城市地区。基于人群的、临床的和/或政策策略和干预措施，旨在解决这些可改变的风险因素，可能有助于减少农村人口中所经历的癌症差异。
